Blood Press. 2026 Jan 29:1-20. doi: 10.1080/08037051.2026.2624257. Online ahead of print.
ABSTRACT
BACKGROUND: Effective management of arterial hypertension remains a major global health priority due to its high prevalence and substantial burden of cardiovascular (CV) and renal complications. In response to emerging evidence and the need to improve real-world implementation of best practices, three international organisations have released independent clinical practice guidelines: the European Society of Hypertension (ESH, 2023), the European Society of Cardiology (ESC, 2024) and the American College of Cardiology/American Heart Association (AHA/ACC, 2025)1. Despite a shared objective of improving BP control and CV outcomes, these guidelines differ in several key clinical recommendations.Aim and Methods: This society-endorsed consensus document, jointly developed by the Portuguese Society of Hypertension and the Portuguese Society of Cardiology, aims to harmonise partially divergent hypertension guidelines into coherent and clinically applicable recommendations. It provides a comparative and pragmatic synthesis of the 2023-2025 guidelines, structured according to the M.A.P.E. framework (Measure, Assess, Prescribe, Evaluate), to support decision-making in routine clinical practice.
RESULTS: Across European guidelines, there is a strong alignment in the definition of hypertension (systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg), CV risk stratification, consistent recommendations on lifestyle interventions, and the first-line use of combination therapy of two drugs out of four. Divergences arise in BP classification systems, initiation thresholds, dosing strategies, and target BP goals. The 2025 AHA/ACC Guidelines differ by adopting lower diagnostic and treatment thresholds (≥130/80 mmHg) and early pharmacological intervention based on individual CV risk. The Portuguese consensus acknowledges these differences and supports a risk-based approach grounded in randomised trial evidence, feasibility in routine clinical practice, and patient safety, recognising office BP as the basis for treatment decisions.
CONCLUSIONS: By harmonising European and American guidelines, this Portuguese consensus aims to reduce clinical uncertainty and optimise hypertension management in real-world practice by providing clear and evidence-informed clinical recommendations.
PMID:41607194 | DOI:10.1080/08037051.2026.2624257